Fillable Form 1: Application Form This application form should (Australian Hydrographic Service)

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Form 1: Application Form This application form should (Australian Hydrographic Service)

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Commercial in Confidence when completed
Application Form
AUSGeoTIFF
Geo-referenced raster images of the Australian Chart Series for
non-navigational purposes
AusGeoTIFF
Application Form
Form 1
April 2020
This application form should be used to apply for a licence to use raster images of
Australian Navigational Charts for non-navigational purposes where you do not wish to
create a marketable product.
Privacy Statement: Any personal details submitted will only be used for the purpose for
which they are provided. We will not use your personal details for any other purpose, and
will not disclose them to any other party without your consent, except in the unlikely event
of an investigation by a law enforcement agency.
1.Your Details
Name
Position
Organisation
Address for correspondence
Address for dispatch of goods
(if different)
Telephone Number
Fax
E-mail
Commercial in Confidence when completed
Application Form
AUSGeoTIFF
Geo-referenced raster images of the Australian Chart Series for
non-navigational purposes
2. Your Organisation
Some organisations or individuals may not have to pay the full AusGeoTIFF price.
Reductions or waivers may be granted to the following kinds of applicants:
• some Commonwealth, State and Local Government organisations,
• academic research,
• some educational publications (such as school text books or examination papers),
• organisations who provide significant material to us without charge.
ABN
What type of applicant are
you?
If you believe that you may
qualify for a waiver or
reduction of our standard
charges please explain your
reasons here.
3. Intended Use of AusGeoTIFF
What systems will you be
using the AusGeoTIFF
images in?
ArcInfo ER Mapper Imagine
Arc View GeoMedia MapInfo
Caris Other (please specify )
Describe how you will use
AusGeoTIFF and who will
benefit.
Commercial in Confidence when completed
Application Form
AUSGeoTIFF
Geo-referenced raster images of the Australian Chart Series for
non-navigational purposes
Do you require a site licence?
(additional fees apply for site
licenses)
Yes No
If yes, how many computers
will you use AusGeoTIFF on?
2-5 6-10 10+
4. Use of Contractors
Will AusGeoTIFF be used by contractors? If so, give details of each company or
organisation.
Company Name
Address
Contact Person
Telephone
Fax
E-Mail
5. Charts
Provide a list of charts that are required. The charts available can be found using
the Australian Chart Index available on our website www.hydro.gov.au
6. Monthly Update Service
If you would like to purchase a monthly update service, place a tick in the update box next to
each chart you would like to update on the attached Chart Selection List.
Commercial in Confidence when completed
Application Form
AUSGeoTIFF
Geo-referenced raster images of the Australian Chart Series for
non-navigational purposes
7. Declaration
I confirm that the information I have supplied is true and accurate to the best of my knowledge.
I agree to forward any changes to the information which I have supplied prior to a licence being
granted.
Signature of applicant
Name (in capitals)
On behalf of
(name of organisation)
Date
Please return the completed form to:
Licensing Manager
Australian Hydrographic Service
Locked Bag 8801
Wollongong NSW 2500 Australia
E-mail: hydro.licensing@defence.gov.au
For information on AusGeoTIFF, please consult the following brochures available at
www.hydro.gov.au:
Brochure 1
Brochure 2
Brochure 3
Brochure 4
Brochure 5
Brochure 6
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Form 1: Application Form This application form should (Australian Hydrographic Service)

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Completed 4 August 2020

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